Is The
AIDS Virus A Science Fiction?
Immunosuppressive Behavior, Not HIV, May Be the Cause of AIDS
By Peter H. Duesberg & Bryan J. Ellison
Policy Review Summer 1990

A report
published by the Centers for Control (CDC) on June 5, 1981,
startled the medical community in the United States. This report
described five unusual medical cases that had been observed
between October, 1980 and May, 1981. All five had developed
cases of Pneumocystis carinii pneumonia. P. carinii is a microbe
present in the lungs of most healthy people, but can cause sickness
when the host immune system has somehow been severely weakened.
Immunosuppression in these cases was confirmed by the presence
of various other opportunistic infections. Medical authorities
were most surprised at the identity of the patients: these cases
with severe immune collapse all involved 20-to-40-year-old men,
typically considered a healthy age group. Further, all of these
men were homosexual.

A subsequent
report by the CDC on August 28 listed 21 additional cases showing
similar severe immune suppression problems. Along with P. carinii
pneumonia, esophagal candidiasis (a yeast infection), and other
diseases typical of immune deficiencies, a number of these patients
displayed a rare condition known as Kaposi's sarcoma. This is
a growth in the blood vessel linings, manifesting as reddish lesions
on the skin. The CDC referred to these new patients with strange
combinations of conditions as "previously healthy homosexual
men." Since growing numbers of healthy men should not simultaneously
develop severe sickness, the full complement of observed in them
was grouped together into a syndrome presumed to have some single
underlying cause; first called Gay_related Immune Deficiency (GRID),
the syndrome eventually became known as Acquired Immune Deficiency
Syndrome, or AIDS.

Since this
syndrome was first defined, over 130,000 Americans have been diagnosed
with AIDS, and over 80,000 of these have died. Male homosexuals
continue to comprise the major risk group for AIDS, but intravenous
drug users, blood transfusion recipients, and hemophiliacs also
have been included as AIDS victims. Since 1981, the list of indicator
diseases for diagnosing AIDS has been expanded by the CDC to include
P. carinii pneumonia, tuberculosis, Kaposi's sarcoma, dementia,
lymphoma, candidiasis, diarrhea-altogether 25 conventional diseases.
The most commonly diagnoses of these is P. carinii pneumonia,
found in about 53 percent of new AIDS cases last year, followed
by wasting syndrome in 19 percent, candidiasis in 13 percent,
Kaposi's sarcoma in 11 percent, and dementia in 6 percent.

Federal funding
has grown with the syndrome. In the earlier years of the epidemic,
spending was at a few million dollars a year. Since 1984, with
the announcement by the Secretary of Health and Human Services
that an AIDS virus had been discovered and could possibly affect
the general public, spending on AIDS research, education and treatment
has grown enormously, and has now reached $2.9 billion for this
fiscal year.

Immune
Breakdown.

As a syndrome
defined by several conventional diseases, AIDS was seen as being
the result of an underlying deficiency in the immune system. In
many of the early patients, the main abnormality appeared to be
a depletion of one specific subgroup of cells in the immune system,
the T-helper cells; these cells respond to the presence of invading
microbes and stimulate other cells to produce the proper antibodies
against new germs. But the actual estimates of "proper"
levels of T-helper cells were largely speculative because little
research had previously been done on this aspect of the immune
system. Because the average number of T-helper cells in AIDS patients
was lower than among other people, the notion developed that this
syndrome was caused by something depleting these particular cells.

Among the
earliest proposed causes of AIDS were the nitrite inhalers used
almost exclusively by homosexuals in the bath houses. Some early
work connected their use to the incidence of Kaposi's sarcoma,
but this hypothesis could neither account for the full spectrum
of AIDS diseases nor for AIDS in heterosexuals, and it was soon
dropped.

Most of the
interest instead focused on the search for an infectious agent
causing AIDS. Beginning with the first report of AIDS cases, the
CDC noted that all of the early cases had either current or previous
infection by cytomegalovirus, a member of the herpes group of
viruses. Cytomegalovirus was know to have immunosuppressive ability,
and this possibility was pursed for some time. But, because this
virus was widespread in the general population, and since not
all AIDS patients had been infected, this was ultimately abandoned
as well.

The question
of the cause of AIDS was officially settled on April 23, 1984,
when the Department of Health and Human Services announced the
isolation of the AIDS virus. Called Lymphadenopathy-Associated
Virus (LAV) by its French discoverer, and Human T-cell Leukemia
Virus III (HTLV-III) by American scientists, it has since 1986
been officially referred to as the Human Immunodeficiency Virus
(HIV). The belief that HIV causes the immunosuppression underlying
AIDs became the generally accepted view in the scientific community
with the 1986 benchmark publication "Confronting Aids,"
published by the National Academy of Sciences and the Institute
of Medicine. The predominant view today holds that this virus
causes immune deficiency by depleting the body of T-helper cells,
dooming 50 to 100 percent of infected people to develop AIDS and
die.

However,
since 1987 an increasing number of medical scientist and physicians
have been questioning whether HIV actually does cause AIDS. Some
of these dissident scientists simply demur that HIV has never
been proved to cause AIDS, and therefore its role is unclear.
Others believe that the evidence essentially rules out HIV as
playing any part in AIDS at all. Many more maintain that HIV cannot
cause AIDS alone, but may need additional, unidentified factors.
Currently, most of these doubters prefer not to be quoted, out
of fear of losing research funding or of disapproval by peers.
This challenge is so far a minority view, due largely to inadequate
attention provided by media sources. In spite of the well-established
credentials of many of the more outspoken opposition scientists,
their views have yet to be heard by most Americans.

The Case
for HIV

An article
by Luc Montagnier, French discoverer of HIV, and Robert Gallo,
the leading American HIV researcher, in the October 1988 issue
of "Scientific American", discussed in part the rational
behind searching for an AIDS virus in the first place. Noting
the sudden onset of diseases previously considered uncommon in
young men, they argued that only the recent introduction of a
new microbe could account for this increase.

The exact
means by which HIV kills T cells is still not known. Gallo and
his colleagues have repeatedly pointed out that although the mechanism
may be unclear, the evidence that HIV does cause AIDS has been
well established. They primarily cite evidence from epidemiology,
they study of how diseases spread.

They point
out that the people who get AIDS are those who have antibodies
to HIV. Studies following HIV-infected people in AIDS risk groups
over time observe a progression to sickness characteristic of
AIDS.

Proponents
of the virus-AIDS hypothesis stress the geographic correlations
between AIDS and HIV infection. AIDS is most common in Africa
and in cities such as New York and San Francisco were HIV is widespread.
Neither AIDS nor HIV can be found extensively in Asia or the Soviet
Union and Eastern Europe.

Proponents
also give special attention to the more than 1,600 infants, over
1,100 hemophiliacs, and roughly 3,000 recipients of blood transfusion
in the United States who have developed AIDS years after being
infected with HIV. The October 1988 Scientific American cited
an example of a hemophiliac family, in which the father and son
both contracted HIV and developed AIDS. A well-publicized example
was Ryan White, the young hemophiliac who contracted HIV, developed
AIDS, and recently died at the age of 18. The late California
legislator Paul Gann, who led the Proposition 13 anti-tax movement,
also received some attention, having received HIV through a blood
transfusion and subsequently developing a fatal case of AIDS pneumonia.
Since infants, and the majority of hemophiliacs and transfusion
recipients, can be presumed to be neither intravenous drug abusers
nor active homosexuals, their principal apparent risk factor has
been their infection by HIV.

Although
most viruses cause disease within weeks of acute infection, HIV
purportedly causes AIDS after an average latent period of 10 to
11 years. To support this notion, defenders of the virus-AIDS
hypothesis cite models of other viruses that cause in animals
and humans, often with latent periods of 10 to 40 years between
infection by the virus and the development of disease. Such "slow
viruses" have been credited in recent years for various leukemias
both in humans and animals, as well as for certain other specific
cancers. Female cervical cancer is widely thought to be caused
by assorted strains of human wart viruses, while the cancer known
as Brukitt's lymphoma is often believed to be the result of the
virus that also causes mononucleosis.

Further,
Simian Immunodeficiency Virus and Feline Immunodeficiency Virus,
both viruses in the same class as HIV, often cause sickness or
even death when introduced into laboratory monkeys and cats, with
conditions referred to as equivalents of human AIDS.

Koch's
Postulates Unmet

Scientists
dissenting against this widely accepted virus-AIDS hypothesis
often raise as their most fundamental point that this theory has
simply never been proven. Introduced by Robert Koch in the past
century, the classical criteria for showing whether a disease
is infectious and caused by a particular microbe are called Koch's
Postulates. But as the Harvard molecular biologist Walter Gilbert,
a Nobel laureate, points out, these criteria have not been met
for HIV:

Postulate
1: The germ must be found in the affected tissues in all cases
of the disease. However, no HIV at all can be isolated from at
least 10 to 20 percent of AIDs patients; until the recent advent
of highly sensitive methods, no direct trace of HIV could be found
in the majority of AIDS cases. Further, HIV cannot be isolated
from the cells in the lesions of Kaposi's sarcoma, nor from the
nerve cells of patients with AIDs dementia.

Postulate
2: The germ must be isolated from other germs and from the host's
body. The amounts of HIV in AIDS patients are typically so low
that the virus must be isolated indirectly from a patient, only
after first isolating huge numbers of cells from the patient and
then reactivating the virus. In classical diseases, enough active
virus is present to isolable directly from the blood or affected
tissue; anywhere from one million to one billion units of virus
per milliliter of body fluid can be found during the time most
viruses cause , and viruses of the same class as HIV are found
at levels between 100,000 and 10 million units per milliliter.
HIV, on the other hand, is usually found in less than five units
and never in more than a few thousand units per milliliter of
blood plasma.

Postulate
3: The germ must cause the sickness when injected into healthy
hosts. HIV has not been shown to cause disease when injected experimentally
into chimpanzees, nor when accidentally injected into human health
care workers, even though the virus successfully infects those
hosts. If for ethical or other reasons this third postulate cannot
be tested from some particular germ, strong alternative evidence
has to be provided by specific therapies that neutralize the microbe
and thereby prevent the disease; such therapies would include
antibiotics or vaccines. However, no therapies or antibodies against
HIV have been able to prevent AIDS diseases, although new drugs
and vaccines are continually being proposed.

Postulate
4: The same germ must once again be isolated from the newly diseased
host. Until the third postulate can be met, this one is irrelevant.

The failure
to meet Koch's postulates raises questions about whether AIDS
is even infectious at all. Koch's postulates are the standard
criteria for determining disease agents. When they are not met,
strong alternative evidence must be produced to support any infectious
agent hypotheses.

The burden
of such proof is therefore on those who claim that HIV causes
AIDS, as noted by Beverly Griffin, director of the Department
of Virology at the Royal Postgraduate Medical School in London.
This burden is especially high for HIV hypothesis supporters in
view of the special characteristics that had to be attributed
to HIV in order to connect it with AIDS. First, the virus had
to be credited with a latent period of several years between infection
and AIDS. But when diseases are said to occur only years after
infection by a virus, it can be difficult to be sure that other
risk factors have not instead caused the disease. Second, because
HIV is conspicuously absent form lesions, scientists had to hypothesize
that the virus caused disease by indirect means in the body, in
spite of a troubling lack of evidence for such notions. Inventions
such as these can be used to blame virtually any microbe for any
disease.

Definitional
Paradoxes

A second
set of criticisms of the HIV hypothesis concerns the clinical
definition of AIDS. This definition involves a list created by
the CDC in 1987 of about 25 conventional diseases; if any one
of these is diagnosed, and antibodies against HIV can be found
in the same patient, a diagnosis of AIDS is made. The list includes
not only Kaposi's sarcoma and P. carinii pneumonia, but also tuberculosis,
cytomegalovirus, herpes, diarrhea, candidiasis, lymphoma, dementia,
and many other diseases. If any of these very different diseases
is found alone, it is likely to be diagnosed under its classical
name. If the same conditions is found alongside antibodies against
HIV, it is called AIDS. The correlation between AIDS and HIV is
thus an artifact of the definition itself.

Another definitional
concern relates to how a single virus could lead to such a spectrum
of diseases. Harry Rubin, biologist at the University of California
at Berkeley and recipient of the Lasker Prize for his work on
viruses, is one of several dissenting scientists who argue that
these should never have been grouped together, and that no new
microbe is needed to explain the occurrence of these old conditions
among behavioral AIDS-risk groups in recent years.

The rational
for combining these separate diseases into a single syndrome is
the assumption that they all have a single underlying cause: immune
deficiency purportedly caused by HIV. However, immune system failure
cannot account for some of the conditions on the AIDS lists, particularly
the cancers and dementia. While many scientists still hope to
find ways of fighting cancer using the immune system, experimental
work has long shown that cancers do not necessarily increase in
the presence of immune deficiencies. After all, the immune system
can only fight foreign particles, but cancer cells are actually
part of the patient's body. Dementia is likewise not directly
prevented by the immune system, because antibodies do not normally
reach brain tissue. Microbes that reach the central nervous system
are free to grow without interference by the antibody defenses,
even in a fully healthy individual. HIV must therefore be credited
with doing far more than simply depleting the immune system; it
would have to destroy neurons and make cancerous certain other
cells, while simultaneously killing or preventing the growth of
immune cells. Indeed, any AIDS microbe would face the same difficulties.

Little
Detectable Virus

A third difficulty
with the HIV hypotheses is that there is very little detectable
virus in AIDS patients. Fewer than 1 out of every 10,000 of the
host's T-helper cells are actively infected by HIV even during
AIDS; moreover, the tiny amount of virus produced by these few
cells is neutralized by the same antiviral antibodies that are
detected by the "AIDS test." Fewer than 1 in 500 of
a host's T cells contain even dormant HIV which can only be found
by isolating these cells from the body and stimulating them artificially
with compounds that help reactivate these latent viruses from
within the cells. The resulting difficulty, and often impossibility,
of isolating HIV from AIDS patients make the presence of antibodies
against the virus the only practical basis for diagnosis.

It is very
difficult to understand how HIV would be able to devastate the
immune system while never infecting more than a tiny fraction
of its cells. Even if every infected cell were killed, the number
of T cells lost at any time would be roughly equivalent to the
number lost through bleeding from shaving. Such losses could be
sustained indefinitely without affecting the immune system, because
the body constantly produces new T cells at far higher rates.
Virtually no reactivation of the virus occurs when AIDS patients
develop sickness, leaving unexplained how the virus could possibly
case immune suppression, and then only after years of latency.
After the body produces antibodies against HIV, the virus remains
at low levels for the rest of that person's life, precisely the
same as for all viruses of its class. This would help to explain
why transmitting HIV is typically so difficult; antibody-positive
people have almost no virus to spread.

A few studies
describe rare cases of brief flu-like conditions shortly after
infection by HIV but these patients recover rather quickly once
their immune systems have created antibodies against HIV. This
emphasizes the paradox: how could an inactive virus cause a fatal
after 10 years, when the same virus causes at most a mild condition
when it was first active?

Misleading
Animal Models

A fourth
paradox of the HIV hypothesis has been noted by several virologists.
HIV belongs to a class of viruses known as the retroviruses, which
are very simple in structure and contain much less genetic information
than most other viruses. Most types of viruses are lytic, meaning
that they kill the cells they infect and thereby cause disease.
Retroviruses, on the other hand, do not generally kill cells.
Upon infecting cells, they copy their genetic information into
the DNA of their new host cells. From that point forward, retroviruses
depend on allowing their host cells to continue living, while
they slowly produce new virus particles that are ejected from
the cell. Retroviruses are therefore poor candidates to blame
serious diseases on, particularly fatal conditions involving the
deaths of huge numbers of cells, such as AIDS. Indeed, some 50
to 100 latent retroviruses have been found to reside in the DNA
of all humans, passed along to each successive generation for
as long as human beings have existed.

Past research
by Harry Rubin has shown that retroviruses cannot infect any cells
that do not divide. Neurons in the human brain do not divide after
the first year of life, so HIV cannot possibly infect those cells.
This would explain why HIV has not been isolated from these cells,
and confirms the difficulty it would also face in causing dementia.

Harvey Bialy,
research editor of the professional journal Bio/Technology, argues
that the simple genetic structure of HIV does not differ sufficiently
from other retroviruses to account for its supposedly different
behavior. The genetic information carried by HIV is not unusual
for retroviruses; it contains no gene different enough from the
genes of other retroviruses to be a possible "AIDS gene."
In addition, HIV uses all of its genetic information when it first
infects, rather than saving some to be used years later. In other
words, there is no conceivable reason HIV should causes AIDS 10
years after infection, rather than early on when it is unchecked
by the immune system.

Bialy also
points out the misinterpretations made of animal models. Simian
(monkey) AIDS, for example, does not actually resemble human AIDS.
The animals do not develop a wide spectrum of diseases, not do
they suffer any conditions even remotely similar to Kaposi's sarcoma
or dementia. There is no long latent period between infection
by Simian Immunodeficiency Virus and the development of sickness.
The animals become sick within days or weeks after infection,
or not all. The sickness sometimes developed in these animals
by such viruses resembles more the flu-like conditions occasionally
observed in humans shortly after infection by HIV. Such viruses
cause fatal animal only when they are present in large amounts,
and only in highly susceptible inbred animals kept in laboratory
conditions.

Although
a widespread belief holds that certain retroviruses cause other
fatal conditions after long latent periods in sheep, goats, and
horses, these viruses are actually found in the majority of healthy
animals. Only a tiny number of animals develop such diseases,
throwing into doubt the roles of these viruses.

HIV without
AIDS

Arguments
used most often in defense of the HIV hypothesis concern the field
of epidemiology, the study of how diseases spread.

The most
common method used in epidemiology today in searching for the
cause of a disease is to find correlations between phenomena and
their possible causes. The only scientifically conclusive method
is the controlled study, in which two sets of people are matched
for every potentially important factor except for the possible
cause, and the two sets are then compared to see whether one group
is more likely to contract the disease. Only uncontrolled epidemiology
has been cited to support the HIV hypothesis. However, the opponents
of the virus-AIDS hypothesis point to a number of paradoxes in
this uncontrolled epidemiology.

Evidence
increasingly indicates that large number of people infected with
HIV, probably the majority, will never develop AIDS. In 1986,
the CDC estimated the extent of HIV infection to range from 1
million to 1.5 million in the United States. The figure was changed
within the last few months to an ex post facto estimate of 750,000
HIV-positive Americans by 1986, with about one million today.
This revision was based simply on back-calculation models, since
fewer AIDS cases had occurred than expected, the CDC decided that
fewer people must have been infected with HIV than was first estimated.
About 130,000 Americans have been diagnosed with AIDS over the
past decade, fewer than 15 percent of the newly estimate number
of HIV-positive Americans.

AIDS appears
to be levelling off now. Michael Fumento, author of "The
Myth of Heterosexual AIDS," but not an opponent of the HIV
hypotheses, has pointed out a slowing of AIDS diagnoses by late
1987. A study published in the March 16, 1990, issue of the Journal
of the American Medical Association, based on mathematical modeling
of the growth of AIDS, has concluded that this syndrome began
to level off in 1988.

These trends
create a tremendous gap between the large number of people estimated
to be infected with HIV and the relatively few developing sickness.
To accommodate this gap, the CDC has steadily increased its estimate
of the latent period between HIV infection and diagnosis of AIDS
from three or four years to about 10 years at present. Roughly,
for every year that passes, an additional year is added to this
latent period.

Africa's
Non-Epidemic

The situation
in Africa is even more puzzling and casts further doubt on the
HIV hypothesis. Most of the media publicity in America on AIDS
in Africa is based on the large extent of HIV infection, not on
the extent of AIDS cases themselves. Nonetheless, although HIV
infection appears to be extremely widespread, present in many
areas in 10 to 15 percent of the population, the total number
of AIDS cases so far reported in the entire continent of Africa
amounts to merely 41,000. Proponents of the HIV hypothesis often
try to argue that this low figure is the result of under reporting
of AIDS cases. Even in Uganda, however, which has a reputation
for conscientious reporting, 800,000 people are HIV positive,
but only 10,000 are reported to have died of AIDS. A paper and
accompanying editorial in the July 25, 1987, issue of the British
medical journal "The Lancet" argued that AIDS in Africa
is actually not a major epidemic; the paper was written by a doctor
from Cromwell Hospital in London, Felix Konotey-Ahulu, who had
just returned from an extensive investigative tour of the areas
of Africa with the most AIDS cases.

The story
in Haiti is similar. Only 2,3000 AIDS cases have been reported
during the past decade in a country where HIV infection is thought
to be rampant. Even if this number is underreported, the prevalence
of AIDS is much lower than would be predicted by the HIV hypotheses.

No controlled
studies have been conducted to determine whether HIV causes AIDS.
However, one reasonably controlled study of 19 hemophiliacs was
published in the January 1989 issue of the "Journal of Allergy
and Clinical Immunology," in which the patients with HIV
antibodies were compared to those without them The researchers
found no difference in immune deficiency between the two groups,
though the sample size was too small to draw firm conclusions.

Accidental
infection of humans by HIV, by means other than specific risk
behavior, is especially revealing. Some 19 health care workers
in the United States have been presumed infected with HIV by accidental
needlestick or other medical injuries, based on the inability
to identify any other modes of transmission in their cases. One
of these cases was reported in 1988 as having developed AIDS,
but that diagnosis was changed shortly after that patient recovered
spontaneously. Now the CDC claims that two of these workers have
converted to AIDS, but has failed to publish any data confirming
this claim.

Thus, there
are still no confirmed cases of AIDS among health workers after
accidental infection with HIV, whereas the HIV hypothesis would
predict conversion to AIDS of most of these infected health care
workers by this time.

AIDS Diseases
without HIV

A critical
question about the role of HIV is how it is associated with the
various AIDS diseases. One widespread impression holds that many
of the AIDS diseases were extremely rare before 1980, and only
began reappearing with the presumed introduction of HIV. In reality,
not only have all 25 of these AIDS conditions existed for decades
at a low level in the population, but HIV-free instances of the
same diseases are still being diagnosed today. These diseases
are actually increasing in parallel with their HIV-associated
counterparts. A letter by CDC researchers in the January 20 issue
of "The Lancet" reports the existence of male homosexuals
with Kaposi's sarcoma but without HIV. Robert Root-Bernstein,
MacArthur fellow and associate professor of physiology at Michigan
State University, also published a paper in "The Lancet",
of April 25, in which he reviewed the existing literature on the
incidence of Kaposi's prior to AIDS. Since the first recognition
of this condition in 1872, a number of cases have been reported
each year in the United States and Europe. Many of these were
in people under 50 years of age, or even in children-not just
in older men, as originally thought. A number of these cases were
fatal. Some cases were associated with blood transfusions or with
pneumonia, although many were apparently not connected with any
other conditions. Root-Bernstein concluded that during the 1970's
approximately 100 U. S. cases of Kaposi's per year could have
been diagnosed as AIDS. However, Kaposi's sarcoma was not a disease
reportable to medical officials before AIDS, and these cases were
therefore not recognized. Kaposi's was only noticed once it was
found clustered in young homosexual men in 1980-81.

A similar
situation has existed for P. carinii pneumonia. First recognized
in 1911, these conditions may affect a surprisingly large percentage
of the population; a 1973 study of Europeans found that between
1 and 10 percent of the population had postmortem evidence of
this pneumonia. Often P. carinii pneumonia has been associated
with hemophilia, tuberculosis, cytomegalovirus infections, venereal
diseases, and malnutrition. Patients receiving transplants, heavy
antibiotic therapy, or chemotherapy against cancer have also high
rates of this condition. Most cases have been associated with
malnutrition rather than with underlying infectious diseases.
Before the 1980's, this disease was usually diagnosed only by
autopsy; this, combined with the availability of drugs to treat
P. carinii pneumonia in the 1970's, caused low reporting of this
not uncommon disease. P. carinii pneumonia had also probably been
previously misdiagnosed as other types of pneumonia. Easier diagnosis
and clustering of the disease among active homosexuals, played
a large part in focusing renewed attention on this condition with
the beginning of AIDS.

Root-Bernstein
has collected similar data on cryptococcocsis, cytomegalovirus
disease, and progressive multifocal leukoencephalopathy prior
to the AIDS epidemic.

Strange
Distribution of AIDS Diseases

Gordon Stewart,
emeritus professor of public health at the University of Glasgow,
considers the continued restriction of AIDS to very selective
risk group even 10 years after AIDS was first recognized to be
one of the greatest epidemiological weaknesses of the HIV hypothesis.
The distributions of AIDS diseases and HIV infection are also
inconsistent with each other.

Although
AIDS in Africa is evenly distributed between males and females,
over 90 percent of AIDS cases in the United States continue to
be diagnosed in males. This proportion has not changed since AIDS
was first defined. The paradox is emphasized by a study in the
April 18 issue of the "Journal of the American Medical Association"
which examined over one million teen-aged applicants to the military
between 1985 and 1989. In the most extensive study of its kind
yet published, the proportion of males with antibodies against
HIV was found to be identical to the proportion of infected females,
although AIDS is diagnosed in four times as many males as females
for that age bracket. In short, males with HIV are more likely
than females to develop AIDS, even though they have the same virus.

The annual
rates at which HIV-positive people develop conditions diagnosed
as AIDS varies tremendously between different risk groups. The
annual rate among HIV-positive Americans engaging in risk behavior
or who have hemophilia varies from 2 to 25 percent. Though three-quarters
of American hemophiliacs are HIV-positive, only 6 percent have
been diagnosed with AIDS over the past decade.

The total
number of AIDS diagnosed among American infants receiving blood
transfusions continues to increase, with 40 new cases in 1989,
even after the drastic reduction in HIV transmission through the
blood supply four years ago; this is incompatible with the two-year
latent period AIDS is claimed to have in those children.

Health care
workers, who might be thought to have a greater than average risk
of contracting HIV, present another anomaly: three-quarters are
female, yet over 90 percent of these workers diagnosed with AIDS
are male. Stranger still, the CDC reports that 95 percent of them
fall into the same risk groups that 95 percent of all other AIDS
cases do.

In addition
to the inconsistent distributions of AIDS as a syndrome, specific
AIDS diseases develop largely within specific risk groups. This
occurs in spite of all these groups being infected by the same
virus.

For example,
Kaposi's sarcoma in the United States is almost exclusively found
in male homosexuals. Kaposi's is further distinguished by the
fact that it is the only one of the AIDS conditions that has been
declining for several years, while the others continue to increase.
P. carinii pneumonia, on the other hand, has been diagnosed in
an increasing proportion of the total number of U. S. AIDS cases.
The AIDS diseases seen among infants tend to be the typical pediatric
diseases, including tuberculosis, pneumonias, and various bacterial
infections. In Africa, the predominant AIDS disease is a wasting
syndrome, often called "slim disease." While this condition
is seen among some U. S. AIDS patients, it is not nearly as synonymous
with AIDS.

Montagnier's
Startling Admission

Some recent
developments have begun to signal the beginnings of retreat by
the proponents of the HIV hypothesis. A startling admission by
Luc Montagnier, the French discoverer of HIV, was published in
the March 1990 issue of "Research in Virology." Montagnier
demonstrated conclusively that HIV is not able to kill T cells
in culture dishes, contrary to previous arguments raised by the
supporters of the HIV hypothesis.

In that same
paper, Montagnier first suggested that HIV alone may not cause
disease; he offered the possibility of some unidentified bacterium
also being involved. He has since endorsed the suggestion of Shyh-Ching
Lo, of the U. S. Armed Forces Institute of Pathology, who argued
in the May 11, 1990, issue of "Science" that his recently
discovered bacterium Mycoplasma incognitus, might play a role
in AIDS. Montagnier now holds that HIV and the bacterium together
cause the disease. Any mycoplasma, however, would face many of
the same difficulties as HIV; it would not cause the full set
of AIDS diseases, it would have already spread AIDS into the general
population, and most of all, this particular one is not different
enough from other mycoplasmas to account for such unusual abilities.
Mycoplasmas are reasonably common germs, existing throughout the
population, and are responsible for about one-third of the mild
pneumonias sometimes developed by humans. HIV and M. incognitus
may soon be branded as co-factors in causing AIDS, but this would
simply be an invention to try to fill the gaps in any theory that
blames the AIDS diseases on the microbe.

Perhaps the
most spectacular recent study on AIDS was published in "The
Lancet" of January 20, 1990. Researchers at the CDC concluded
that Kaposi's sarcoma is not caused by HIV after all. The bases
for this conclusion were simply that Kaposi's is not observed
to be equally distributed among the AIDS risk groups, and that
HIV-free Kaposi's cases are diagnosed in U. S. homosexuals, arguments
previously raised by the senior author of this article (Peter
Duesberg). While the basic data used in that paper are not new,
this startling admission by CDC epidemiologists marks the first
time HIV has been officially questioned as the cause of any AIDS
disease, although the CDC has still not removed Kaposi's form
the disease listing in the AIDS definition. Nevertheless, the
publication of this paper may have opened the door for more inquiry
of whether HIV is responsible for other AIDS diseases, and whether
those diseases truly belong together as a single syndrome.

The Risk-AIDS
Hypothesis

If a number
of scientists and medical physicians do not believe HIV is likely
to play any significant role in AIDS, what do they consider the
true cause to be? For the most part, the alternative views of
AIDS can be grouped together as the "risk hypothesis"
of AIDS-that the AIDS diseases are entirely separate conditions
caused by a variety of factors, most of which have in common only
that they involve risk behavior. This view does not see AIDS as
being a transmissible condition at all.

Nevertheless,
a risk hypothesis must explain the recent increases in the various
AIDS diseases, and why these have all been concentrated in particular
risk groups. During at least the past decade, the incidence of
these 25 conventional diseases has increased dramatically among
groups in which they were previously rare.

Kaposi's
sarcoma may actually be the most clearly understandable of the
AIDS conditions. As noted above, it has existed at low levels
in the population for as long as it has been recognized. Undoubtedly,
various unidentified factors play roles in bringing on this condition.
But the relatively recent clustering of Kaposi's in homosexuals
may be due to their group-specific use of nitrite inhalants, or
"poppers." These aphrodisiac drugs became popular in
the active homosexual community during the 1970's. Use of these
inhalants began declining after they were suggested as a possible
cause of AIDS, and that behavior change has been followed by a
corresponding decline in the incidence of Kaposi's. Early tests
on animals also implicated these inhalants in Kaposi's. In fact,
this evidence of the dangers of nitrite inhalants prompted Congress
to ban the nonprescription use of these drugs in 1988. While these
nitrites were officially dropped from consideration as a cause
of AIDS because they were not associated with all the AIDS diseases,
they should be strongly reconsidered as agents specific to Kaposi's
sarcoma.

Certain other
diseases on the AIDS list, those not necessarily resulting from
immune problems appear to have better explanations than HIV. Dementia
is most likely the result of extensive use of psychoactive recreational
drugs, and/or undiagnosed syphilis; increased sexual activity
appears to have led to renewed epidemics of venereal diseases,
including syphilis, which is difficult to test for. Wasting syndrome
found most heavily in African AIDS patients, is an endemic condition
produced by the extremes of malnutrition and the lack of sanitation
on most of that continent; the rise in recent years of wars and
totalitarian regimes has served only to worsen conditions. African
sickness was included in the AIDS epidemic merely because HIV
had already been implicated in sickness in the industrial world
and this same virus could be found endemically in Africa.

Most of the
AIDS diseases involve some degree of immune suppression. This
is a condition produced by many different factors. Drug use, particularly
of heroin, is one. Recreational drugs are commonly used by active
homosexuals in the bath houses. Alcohol, heroin, cocaine, marijuana,
valium, and amphetamines can all be found as part of the life
histories of many AIDS patients. When combined with regular and
prolonged malnutrition, as is done with many active homosexuals
and with heroin addicts, this can lead to complete immune collapse.
Antibiotics, when used heavily or over long periods, also wear
down the immune system. Active homosexuals have been among the
heaviest users, often taking large amounts of tetracycline and
other antibiotics each evening before entering the bath houses.

Joseph Sonnabend,
a New York physician who founded the journal "AIDS Research"
in 1983, has pointed out that repeated, constant infections may
eventually overload the immune system, causing its failure; still
worse are simultaneous infections by two or more diseases. "Fast
track" homosexuals have generally experienced repeated bouts
not only of a full spectrum of venereal diseases, but also of
all forms of hepatitis, cytomegalovirus infection, Epstein-Barr
virus infection, and various protozoan infections. They have commonly
developed multiple infections, usually repeatedly.

Procedures
traumatic to the body can play a major role in weakening the immune
system. Almost exclusive to the homosexual community is the practice
of fisting, which like anal intercourse is often damaging to the
rectum. This damage provides access for many infectious agents
into the bloodstream.

Many surgeries
are immunosuppressive because of the trauma itself, or due to
the anesthesia, or from immunosuppressive chemotherapy, or even
from the transfused blood itself. In fact, immune suppression
is proportional to the volume of transfused blood. These problems
may explain the occurrence of AIDS diseases among blood transfusion
recipients; with or without HIV infection, half of all such recipients
do not survive their first year after transfusion.

Hemophiliac
and Pediatric Cases

The question
naturally arises as to why people outside these behavioral health-risk
groups, including hemophiliacs and children, would develop some
of the AIDS diseases. The answers lie in the risk factors too
rarely reported to the public.

Hemophilia
has always been a fatal condition. This has only been partly alleviated
by recent medical advances. Not only are blood transfusions still
frequently needed, but blood clotting factors used by hemophiliacs
today are somewhat immunosuppressive themselves. Interestingly,
the controlled epidemiological study of hemophiliacs, cited above,
found evidence to support the idea that hemophilia may be an inherently
immune-deficient condition on its own. In the case of Ryan White,
now often cited as an example of an AIDS death, the Hemophilia
Foundation of Indiana has confirmed that his death was due to
such complications as liver failure and internal bleeding, conditions
that typically result from hemophilia itself. Indeed, White already
had a severe case of hemophilia, ultimately requiring clotting
factor therapy every day. He also underwent daily AZT therapy,
the dangers of which are reviewed below.

Infants diagnosed
as having AIDS have developed their conditions due to combinations
of most of the above risk factors. Published CDC data shows that
some 95 percent of these babies are born to mothers who are confirmed
drug addicts and/or sexual partners of IV drug users (frequently
a code word for prostitutes), or the babies are themselves hemophiliacs
or recipients of blood transfusions. The risk behavior of many
of their mothers has reached these victims, but their conditions
are renamed AIDS when in the presence of antibodies against HIV.

Finally,
those few AIDS cases in which no risk factors exist are due to
the clinical definition of AIDS. Having contracted, for whatever
reason, one or more diseases on the AIDS list in the presence
of antibodies against HIV, these people are diagnosed as having
this syndrome. In many instances, this means the patients are
not given sufficient conventional therapies for the conventional
disease, but are instead treated with the drug AZT.

Behavioral
Changes in the '70s

Both the
AIDS diseases and the risk factors causing them have increased
before and during the same period that AIDS has been officially
defined. Although homosexuality is older than recorded history,
the "gay liberation" movement in 1969 began a wave of
increasing activity by many homosexuals. Bath houses were opened
in major cities, where both sexual promiscuity and drug use exploded.
The number of sexual contacts per individual jumped to hundreds
or thousands over only a few years, and the diseases discussed
above exploded in frequency a the same time. Chronic disease epidemics
actually became the medical hallmark of homosexuals in New York
and San Francisco. The practice of fisting appears to have begun
in the early 1970's, along with the use of nitrite inhalants.

Drug use
among other groups also exploded beginning in the 1960s, with
the use of such substances as heroin and cocaine having multiplied
several times since then; the National Narcotics Intelligence
Consumers Committee reports that the consumption of cocaine alone
increased five-fold from 1978 to 1988. During this same period,
continually greater volumes of blood have been used for increasingly
complex surgical operations. Given the dramatic increases in these
risk factors in precisely the groups developing AIDS, the appearance
of young male homosexuals with multiple diseases in 1980 add 1981
should never have been a surprise; indeed, the first five homosexuals
diagnosed with this syndrome in 1981 were all heavy uses of nitrite
inhalants, an indicator of the risk behavior practiced by all
of the early AIDS cases.

The risk
hypothesis explains the many paradoxes of AIDS and HIV. By considering
AIDS not a single infectious disease or syndrome, but rather a
set of separate conditions with different risk factors contributing
to each case, it resolves the difficulties of the HIV hypotheses:

why Koch's
postulates cannot be met for HIV;

the long
and inconsistent latent periods between HIV infection and AIDS;

why HIV
would be able to devastate the immune system while never infecting
more than a tiny fraction of its cells;

the fact
that HIV is to different enough from other retroviruses to account
for its supposedly different behavior;

the predominance
of males in AIDS cases in the U.S., which is consistent with
the predominance of males among heavy drug abusers;

the presence
of AIDS-like diseases without HIV;

the saturation
of the number of AIDS cases at levels far below the number of
HIV infections;

the enormous
diversity, and risk-group specificity, of the different AIDS
diseases; and

why controlled
studies, though few and incomplete, show no difference in sickness
between people with HIV and people without.

Instead the
risk hypothesis suggests that AIDS diseases can be attributed
to the explosion in drug use and multiple infections associated
with sexual promiscuity among certain sectors of the population.
Hemophilia is a separate risk factor.

The risk
hypothesis also accounts for the rough correlation between HIV
infection and the development of various diseases; because HIV
is difficult to transmit, it has naturally become a surrogate
marker for risk behavior. Those people with the most risks are
often the ones most likely to spread such an inactive microbe.

AZT Toxicity

If the virus-AIDS
hypothesis is wrong and the risk hypothesis correct, several important
conclusions follow. The most urgent of these concerns the current
therapy officially approved for AIDS, the drug zidovudine (AZT).
The hope is that AZT, by preventing the copying of DNA within
cells, will prevent the multiplication of HIV in the host. However,
by doing this the drug also kills all actively growing cells in
the patient; chief among these are the cells of the immune system.
This becomes deadly in light of the risk-AIDS hypothesis; inhibiting
HIV would accomplish nothing, while AZT actually produces the
very immune suppression it is supposed to prevent. The effectiveness
of AZT at this task is demonstrated by the fact that it was first
designed in the 1960s for the purpose of fighting immune system
cancers, by killing the rapidly multiplying, cancerous immune
cells; AZT was finally shelved because treated leukemic mice in
laboratory studies died as quickly as those not given AZT. Some
symptoms of AZT toxicity, such as muscle disease and anemia, resemble
those of full-blown AIDS cases.

Two clinical
studies have been published claiming effectiveness of AZT in slowing
the progression of AIDS, but the studies were both terminated
as soon as different results could be found between the treated
and untreated groups. Some medical researchers have become skeptical
of these studies, in part because the double-blind protocol had
broken down: partly due to the immediate toxicity of AZT, both
the patients and the doctors had already found out who was getting
AZT and who was receiving the placebo. Despite these invalidating
faults, the studies have been published anyway and AZT was quickly
approved by the Food and Drug Administration after the first of
these. Interestingly, a recent study by the Veterans Administration,
cited in the March 23/30, 1990, issue of the "Journal of
the American Medical Association," has found no difference
in longer-term death rates between patients treated with AZT and
those given a placebo. Some British and French researchers have
also expressed doubt about AZT's effectiveness, as mentioned in
the same JAMA article.

Despite its
toxicity, most medical doctors currently using the drug believe
it to have some short-term benefits in alleviating symptoms of
AIDS diseases. This may be for two reasons. Because AZT is a non-specific
killer of dividing cells, it is likely to kill cancer cells and
parasitic bacteria at the same time that it kills the immune system
cells of the host; however, while AZT may temporarily fight the
opportunistic diseases, its depletion of the immune system and
other crucial cells makes it more difficult for the patient to
fight off disease later. The other reason for an apparent benefit
of AZT lies in the observation that many patients on this drug
experience short-term increases in their immune system cells.
This, however, is a temporary pseudo-benefit; when the body is
initially exposed to any toxin that depletes its blood cells,
a compensatory reaction begins to produce large quantities of
new blood cells to replace the poisoned ones. The temporary increase
in all blood cells, including immune cells, is likely to be the
result of the body's reaction to AZT, which later proves futile
in the continued presence of the drug.

Federal agencies
are not promoting and even financing the application of this drug
not only for patients with full-blown AIDS, but now even for people
without symptoms, including pregnant mothers and children; some
50,000 patients worldwide are now undergoing treatment. Many other
AIDS therapies now under consideration, such as the new drug ddI
(dideoxyinosine), operate in the same basic way. Even if the HIV
hypothesis were correct, this approach would be irrational, since
HIV is inactive by the time AZT is administered.

Misguided
Programs

The risk-AIDS
hypothesis also calls into question the direction of current AIDS
education programs. Condoms and sterile needles may limit the
transmission of hepatitis and other infectious diseases, but they
do not guard against he immunosuppressive effects of heroine,
cocaine and overuse of antibiotics. Therefore education programs
that promote condoms and sterile needles without emphasizing the
danger of the risk behavior itself-particularly drug-taking-may
inadvertently encourage spread of the disease.

With respect
to AIDS itself, the risk hypothesis should reduce the fear of
HIV infection. Those people not practicing risk behavior nor subject
to severe medical problems need not worry about AIDS. There is
no need to trace the sexual partners of HIV positive, nor to exclude
from the country those who have been infected by the virus. Neither
policemen nor health workers nor school classmates need to be
concerned about contracting HIV from antibody-positive people.
Legitimate concerns will still remain about tuberculosis, hepatitis,
and other contagious diseases often associated with AIDS. But
infection by HIV would not be significant in itself.

For those
people who do develop AIDS-like diseases, regardless of infection
by HIV, several steps would be advisable. The use of AZT and similar
antiviral-specific drugs should be avoided, while conventional
therapies directed against the specific diseases might be considered.
Such therapies have previously included drugs for each illness,
such as pentamidine for P. carinii pneumonia, as well as limited
use of antibiotics and vaccinations; but none of these particular
approaches is necessarily endorsed by the authors of this article.
Doctors should treat each condition separately, and should seek
to determine the underlying causes in each individual's case;
patients should insist on this approach from their doctors. But
perhaps the most useful action for any such patient to take would
be the ending of any risk behavior. Unfortunately, no studies
have been done, but anecdotal case descriptions exist of AIDS
patients who recover after ending drug use, sexual promiscuity,
and prophylactic antibiotic use, and who improve their nutritional
status.

Significantly,
a June 10, 1990, "Parade" magazine survey of 13 AIDS
survivors who have lived more than five years since their diagnosis
showed a majority rejecting AZT. "It's incredible, isn't
it," said one survivor, Mike Leonard, "that the drug
designed to save you can also kill you."

Public policy
questions raised by the risk hypothesis mostly concern federal
funding patterns. The HIV hypothesis has not yet saved a single
life, despite federal spending of $3 billion per year. In place
of the current research funding policy, which exclusively fiances
HIV-related AIDS research, studies on the causes of the separate
AIDS-diseases and their appropriate therapies might be conducted.
The rest of the $3 billion that will be spent on the virus-AIDS
hypothesis in the next fiscal year might then be saved and returned
to the taxpayers, before it can do more harm. *

The editor
of Policy Review got a lot of letters. Some were published
in the next issue, together with a respons by Duesberg and Ellison.
They can all be found here.